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According to Allergy UK, allergies are ‘the most common chronic disease in Europe’. The UK has some of the highest prevalence rates of allergies in the world, with 20 per cent of people affected also dealing with the prospect of an asthma attack, anaphylactic shock, or even death from an allergic reaction on a daily basis.
This represents a significant cost to the NHS. In 2004, researchers estimated the cost of treating allergy-related illness at £900 million, and in the ensuing years, there has been a 200-300 per cent increase in anaphylaxis-related admissions. According to Allergy UK, eight per cent of GP consultations involve allergies. So, what are the main types of allergies, and how can you help people manage them?
Allergic contact dermatitis
Allergic contact dermatitis develops after skin comes into contact with a specific substance. Substances that commonly cause allergic contact dermatitis include nickel and rubber, and chemicals found in some cosmetics.
Symptoms include itchy and/or sore skin and, occasionally, blisters that may weep. If on the hands, allergic contact dermatitis can be extremely painful, and even affect use of the hands as cracked skin and fissures can cause problems.
Pet allergy
Pet allergy is caused by protein in a pet’s saliva, urine or shed skin particles. While it’s commonly assumed that pet hair is the source of the allergy, the skin particles contain the most protein and cause the most problems. In cats, the allergens are mostly found on skin and fur, while in dogs, it’s found mostly on hair, dander and saliva. In rodents like mice or hamsters, urine is the main source.
Pet allergy symptoms can be mild or severe, and include cough, sneezing, wheezing and breathing difficulties. Watery, red, itchy eyes, a skin rash (or existing eczema flare-up) can also be a sign. In extreme cases, pet allergy can cause potentially life-threatening anaphylaxis.
“Remember to stock a variety of generic products to cater for those who may not be able to afford a branded version”
Food allergy
The most common, triggered by the immune system producing immunoglobulin E (IgE) antibodies. Symptoms occur a few seconds or minutes after eating and are more likely to lead to anaphylaxis
Not caused by IgE, but by other cells in the immune system. Can be harder to diagnose due to the length of time between eating and symptoms developing. (It can take hours)
These can cause symptoms from both types of allergies. Common reactions in food allergies include abdominal pain, vomiting, diarrhoea; skin itching or swelling or respiratory symptoms like sneezing, wheezing, coughing and a runny nose.
Allergy or intolerance?
Food intolerance reactions don’t involve the immune system in the same way as allergic reactions, but although they aren’t life threatening, they can still impact a person’s life.
Reactions are usually delayed for several hours – sometimes even for days after eating the offending foods, and are usually felt in the gut, with bloating, diarrhoea, constipation and IBS commonly present. In some cases, there may also be skin reactions like eczema and joint pain.
Anaphylaxis
In its 2016 guidelines, the British Society of Allergy and Clinical Immunology suggested adrenaline auto-injectors should be prescribed long term to people:
- Who have suffered an anaphylactic reaction where the cause is unknown (idiopathic anaphylaxis)
- Who have suffered an anaphylactic reaction where the known allergic trigger cannot easily be avoided
- Who are allergic to high-risk allergic triggers (e.g. nuts), with other risk factors such as asthma also present, even if the reaction was relatively mild
- Who had a reaction in response to trace amounts of the allergic trigger
- Where an anaphylactic reaction triggered by food is only likely to occur if that food is eaten around the time of physical exercise (known as food-dependent exercise-induced anaphylaxis or FDEIA)
- Where other significant risk factors are present (such as asthma in someone with a food allergy).
In its 2017 guidelines, the Medicines and Healthcare products Regulatory Agency (MHRA) recommended prescribing two adrenaline auto-injectors, to be carried at all times.
Danger signs for anaphylaxis
Pharmacy advice
Vinay Patel, services and contract pharmacist at Alphega Pharmacy, says: “Allergen avoidance strategies coupled with the regular use of antihistamines can significantly impact the extent to which an allergy affects an individual, and pharmacists should consider advising customers on both pharmacological and non-pharmacological approaches.
“Symptoms such as itchy, red or watery eyes can be managed through use of antihistamine eye drops, and regular use of saline-based nasal sprays or irrigation devices can serve to loosen mucus and clear a blocked nose. Applying petroleum jelly to the nostrils can create a physical barrier that traps allergens before they contact the inside of the nose, and recommending customers dust their homes with a damp cloth and vacuum regularly can help to limit exposure to allergens.”
As well as playing to their key strength of providing advice to customers on the best products for their symptoms, Patel suggests that pharmacies should:
- Ensure they are stocking the key brands, especially those being advertised by manufacturers during the season as these will have high customer awareness
- Take advantage of Alphega Pharmacy promotions to remain competitive.
- Display these promotions with supporting point of sale in visible locations for GSL lines in order to gain impulse sales, especially in areas of high footfall or where customers wait for their prescriptions.
He adds: “Remember to stock a variety of generic products to cater for those who may not be able to afford a branded version and who would otherwise go without treatment or seek these products at supermarket level.”
How and when to use an adrenaline auto-injector
The UK Resuscitation Council recommends giving adrenaline as soon as there is stridor (noisy breathing), respiratory distress, wheezing or clinical signs of shock. It’s vital that the patient is taken to hospital urgently.
Anaphylaxis UK suggests that community pharmacists have an important role to play in supporting patients in terms of teaching them how to use their adrenaline auto-injectors (AAIs) and what they should do in an emergency.
“Also reiterate key messages, such as making sure the patient is carrying their two AAIs with them at all times, and how best to store their AAI devices (not exposing them to direct sunlight, don’t subject them to excessive heat or cold temperatures),” it advises.
Pharmacists should signpost people to anaphylaxis.org.uk for help with auto-injector techniques, and to the maker’s website for further information, as different injectors may have different techniques. “It’s important to mention that each brand also has a free expiry alert service that all patients can sign up to and be notified when their device is reaching its expiry date,” says the charity. “This information should be repeated with the patient each time an AAI prescription is dispensed.”
Pharmacy staff should make sure that people know how to use their replacement pens in an emergency, and patients must continue to always carry two pens at all times.
How to optimise your allergy category
- Use the point of sale provided by manufacturers at the counter and on the fixture to raise awareness. This will help highlight the ranges and provide customers with key information that can assist them with their choices
- Follow the latest planograms – this will help you stock an optimal range of remedies for your size of fixture
- If your allergy management range is obscured from the customer by shelving or display stands, relocate the category to eye-level by moving less seasonally important categories (such as cough and cold) lower on the fixture. Remember to add the point of sale to draw customers’ attention to the new location of the range.
Pharmacy testing for allergies
A basic allergy test measures total levels of IgE by pricking a finger and testing the blood to find out whether the IgE level is raised. Patients can then have further allergy blood tests to see whether specific allergens can be identified.
An in-pharmacy allergy screening service usually involves a short consultation to find out about the patient’s symptoms, followed by a skin-prick, patch test or blood test, which will be sent away for analysis. If the results show an allergy or intolerance, pharmacy teams need to make sure they follow up with advice about how to manage the symptoms and signpost to sources of specific guidance and support.
With so many people experiencing allergy symptoms, it could make sense to consider offering an allergy test and treat service. However, even if you have identified demand for the service, you need to consider the practicalities before going ahead.
- Will your pharmacy need extra facilities to accommodate allergy testing services?
- Do you have a private area for consultations?
- If you plan to carry out blood tests on the premises, you’ll need to organise for the disposal of sharps and clinical waste and carry out assessment procedures and referral protocols.
Training for the whole team will also be necessary – covering the test and treat pathways. They will also need to be clued up about the ways that they can promote the service, including how to engage with potential patients, identify people who might benefit from the service and perhaps take on some of the associated administration tasks.
Hani Dajani from Dajani Pharmacy in London started running allergy testing as part of the pharmacy’s blood testing services. While the service is “very new”, Mr Dajani says that they decided to offer support due to the demand for basic services that GP practices are struggling to offer due to current constraints on the NHS.
He explains: “We have recently started offering non-invasive allergy testing services also which pinpoint precise food allergies.
“Allergies are becoming more and more prevalent and patients are wanting to know what exactly is causing them and how best to deal with them effectively. So far, the response to this service has been very positive.”
Views from the P3pharmacy panel
This is certainly an important category in the pharmacy, especially during spring. Oral antihistamines and steroidal creams are particularly popular. Remedies that help with sore throats and coughs are also popular during the allergy season. Over the past year, we have seen an increase in the sale of allergy management products. This may be because the public are now consulting more pharmacists about their conditions as opposed to seeing their GPs due to the expertise and accessibility of community pharmacists.
Jainil Patel, Hollowood Chemists, Manchester
Allergy is an important area for us all year round. While we get mostly hayfever queries during spring and summer, we get asked about treating other allergies such as contact dermatitis all year round. While there are many places these days where customers can purchase allergy remedies, we find that new sufferers want the pharmacist’s advice. We stock a good range of branded and generic products. Popular remedies for nasal symptoms include Benadryl and Benadryl Plus, Sterimar and Beconase, and for eye symptoms, Optrex and Opticrom are popular brands.
Afua Thompson, H.E Matthews Pharmacy, Sutton
This is an important area for our pharmacy and has become more important recently due to higher awareness placed on self care and allergy management by the NHS. Usually, generic antihistamines, and newer nasal corticosteroids sell best for us, and we have noticed more requests for fexofenadine and Sterimar. I’d suggest making a combo adult and kid version of a ‘beat the pollen’ kit made up of antihistamine, nasal spray, eye drops and pocket tissues to increase sales. We’d offer this at a special price and put out a social media message and a poster in window to promote it.
Shilan Shah, Mountford Pharmacy, Barnet
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